July 2017

In this Issue
Click here to learn more about the IPRO ESRD Networks (1, 2, 6 & 9).
SAVE THE DATE: 5th Annual ANNA/IPRO ESRD New England Fall Meeting

On Tuesday, October 17, 2017, the ANNA Southern New England Chapter, along with the IPRO ESRD Network of New England will host an educational meeting at the Mohegan Sun Hotel & Conference Center in Uncasville, Connecticut.

This meeting is open to all members of the ESRD community: administrators, dietitians, nurses, patient-consumers, pharmacists, physicians, social workers, surveyors, technicians, and other interested health care professionals. The meeting provides an opportunity for you and your colleagues to network, share ideas, and celebrate community successes.

Save the Date Flyer (please share with colleagues)

Registration will open on Monday, July 17, 2017
  • $85 for registration completed by August 13, 2017
  • $90 for registration completed by September 10, 2017
  • $100 for registration completed by October 8, 2017
  • $125 for registration completed on-site on October 17, 2017

When paying by credit card, online, there will be a $3.00 transaction fee (in addition to the attendee fee) to process your payment.


Quality Improvement
Vascular Access Reporting in CROWNWeb
CMS has tasked all dialysis facilities with ensuring that clinical data are accurately entered, tracked, and reported in CROWNWeb. To assist with this process, the Network encourages all facilities to compare their internal electronic medical records (EMRs) of patient level vascular access data with what has been entered in CROWNWeb on a monthly basis (both systems should be the same). The CROWNWeb Vascular Access in Use report can be used to support data validation.
If your organization utilizes batch submission, data in your EMRs will override CROWNWeb. If there are discrepancies between the Vascular Access in Use report and your facility's EMRs, please follow the guidelines provided in the Vascular Access Data Cleanup in CROWNWeb to reconcile the data.
Vascular access data are clinical indicators for the Quality Incentive Program (QIP), and errors in reporting can affect payment and, ultimately, your facility's scoring in Dialysis Facility Compare.
If you have questions, please contact Sarah Keehner, RN, BSN, CNN, Quality Improvement Director  for assistance.
CMS Survey and Certification Updates
Recently, the CMS Center for Clinical Standards and Quality/Survey and Certification Group sent out the following memoranda related to the ESRD recertification surveys:

  1. Filling Saline Syringes at the Patient Treatment Station - ESRD facilities may not fill syringes with saline from the single dose saline bag or IV tubing connected to the patient at the dialysis station. This guideline became effective as of July 2, 2017.
  2. Cleaning the Patient Station - To prevent cross contamination, a dialysis station should be completely vacated by the previous patient before the ESRD staff may begin cleaning and disinfecting the station for the next patient. Patients should not be moved from the dialysis station until they are clinically stable.
  3. Hepatitis C (HCV) Screening Exception - All infection control recommendations developed by the CDC and referenced in the Conditions of Coverage for ESRD must be followed with the exception of HCV screening.

Resources to Help Reduce Healthcare Disparities in Vulnerable Populations


CMS has established programs and educational resources to promote the reduction of healthcare disparities in the medically vulnerable patient population. The CMS Equity Plan for Medicare aims to help healthcare practitioners take action to reduce disparities among minority populations.
"The Office of Minority Health's (OMH) vision is to eliminate disparities in healthcare quality and access and to help all CMS beneficiaries achieve their highest level of health." The ESRD Networks, QIO Program, and CMS have made several resources available to support these efforts.
Please click here to access resources that will help staff members better understand how to collect, measure, and reduce disparities in healthcare outcomes. Also included are success stories and best practices for reducing health disparities that can be leveraged by practitioners and care partners.
CMS Proposes 2018 Policy and Payment Rate Changes for End Stage Renal Disease Facilities
Proposed rule builds patient-centered system of care to increase competition, quality and care.
CMS has issued a proposed rule that would update payment policies for the ESRD Prospective Payment System (PPS). The ESRD PPS proposed rule is one of several for calendar year 2018 designed to relieve regulatory burdens for providers; support the patient-doctor relationship in healthcare; and promote transparency, flexibility, and innovation in the delivery of care.

The ESRD Quality Incentive Program (QIP) proposed changes are for payment years 2019, 2020, and 2021, and affect a number of key dialysis data methodologies and quality measures. The proposed rule also invites comment on how to include individuals with acute kidney injury in the ESRD QIP. 
The ESRD proposed rule (CMS 1674-P) can be downloaded from the Federal Register at: https://www.federalregister.gov/public-inspection/
Patient Services
Understanding Shared Responsibilities in Managing Difficult Behaviors in Dialysis

When challenged with the task and responsibility of delivering high quality health care, it is also necessary to take an in depth view and analyze causation of grievances, behaviors and issues that result in patients becoming at risk to having no access to dialysis care.  This can include involuntary discharge (IVD) or involuntary transfer (IVT) of a patient from a facility.  Managing Disruptive Behavior by Patients and Physicians: A Responsibility of the Dialysis Facility Medical Director, published by the Clinical Journal of the American Society of Nephrology, directly speaks to the challenges and opportunities available that require collaborative efforts to uncover root causes, as well as the effectiveness of leadership at the facility level. 

ESRD Networks serve as a resource to both patients and providers for grievance mitigation and conflict resolution.  For assistance, please contact Brittney Jackson, LMSW, MBA, Patient Services Director, at 203-285-1213 or toll-free for patients at 866-286-3773 (ESRD).
How to Improve Your Facility's ICH-CAHPS Scores and Empower Patients
Twice a year the ESRD population is asked to complete the In-Center Hemodialysis Consumer Assessment of Healthcare Providers and Systems (ICH-CAHPS) survey.  The survey gives dialysis patients an opportunity to evaluate the care they receive in their dialysis facility.  CMS uses the survey as a tool to grade the quality of care in dialysis units across the country.  Results determine how much money is paid to dialysis facilities by CMS.  Also, patients can reference facility survey results when comparing multiple dialysis facilities.

This year the Network implemented a quality improvement activity (QIA) to help improve patient responses on the ICH CAHPS, s pecifically focusing on survey questions 10 through 18. These questions address patients' perception about their care, their interactions with dialysis staff; and whether staff members inquired about their well-being.  Patients' physical, mental, and social health all contribute to their quality of life.  A way to assure all these aspects are being addressed is to involve patients and their care partners in identifying and establishing goals to incorporate into their plans of care. 

When staff members work to empower patients using techniques such as motivational interviewing, patients are more willing to set, achieve, and maintain their goals.   Jim Dineen, former dialysis patient, transplant recipient, author, and motivational speaker is an active member of the IPRO ESRD Network Program's Patient Advisory Committee.  On behalf of the Dialysis Patient Citizens (DPC), Mr. Dineen gave a presentation on how goal setting helped him overcome obstacles he has faced in his ESRD journey.  View his presentation, " I can, I will, I did, I will!-Goal Setting," on the DPC website:   http://www.dpcedcenter.org/i-can-i-will-i-did-i-will-goal-setting

For more information about the ICH-CAHPS QIA, click here.
Star Ratings-Demystify the Updated Dialysis Facility Compare Quality Measures

The June 2016 Technical Notes, published on the  Dialysis Facility Compare (DFC) website, can help to demystify quality measures (QMs) that impact facility ratings.  Nine of the thirteen QMs reported on the Medicare DFC website are used to calculate the Star Rating for facilities, based on the October 2016 release date (Calendar Year 2015 data).  Please educate ALL members of your staff about what these measures are and how to speak with patients and family members about their care and what these measures mean to them. 

For more information, including the q uality measures used in Star Rating calculation, please see: https://dialysisdata.org/sites/default/files/content/Methodology/UpdatedDFCStarRatingMethodology.pdf
Ticket to Work: Resources for Patients on SSI/SSDI

Do your patients want to re-enter the work force?  Do they need vocational training?  The Social Security Administration's Ticket to Work Program can help Social Security beneficiaries go to work while they keep their health coverage. Ticket to Work service providers offer Social Security disability beneficiaries (persons who receive SSI or SSDI), ages 18 through 64, who want to work with free job support.  Services offered may include job coaching, job counseling, training, benefits counseling and job placement.  Additional information and resources to help your patients  learn more about the Ticket to Work program and Social Security's Work Incentives are available below :
Five Ways for Healthcare Providers to Get Ready for New Medicare Cards

CMS color logoMedicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative CMS seeks to prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of
Medicare beneficiaries.
CMS will issue new Medicare cards with a new unique, randomly-assigned number called a Medicare Beneficiary Identifier (MBI) to replace the existing Social Security-based Health Insurance Claim Number (HICN) both on the cards and in various CMS systems we use now. CMS will start mailing new cards to people with Medicare benefits in April 2018. All Medicare cards will be replaced by April 2019.

Please click here to read the full article and learn the five steps to prepare your facility to get ready.
KCER Alerts and Recalls

Data Management
CMS Extends Q1 2017 NHSN Deadline for ESRD QIP Reporting
The Centers for Medicare & Medicaid Services (CMS) announced an extension of the deadline for 2017 First Quarter NHSN reporting to Monday, July 31, 2017, at 11:59 p.m. PT. The extension will allow facilities the opportunity to ensure data are complete and accurate in accordance with ESRD QIP reporting policy.
To read the full announcement, please click here.  
The current ESRD QIP measure set is not designed to measure the quality of care provided to patients with acute kidney injuries (AKI). CMS will use only ESRD patient data to calculate the NHSN Bloodstream Infection (BSI) clinical measure, NHSN Dialysis Event reporting measure, or any other measure in the ESRD QIP for Payment Year (PY) 2019; AKI patient data will not be included in the calculations.
However, facilities are encouraged to consider reporting AKI patients on a voluntary basis for internal quality improvement efforts and Centers for Disease Control and Prevention (CDC) public health surveillance purposes. Please use the following guidelines to ensure AKI patient data are excluded from QIP scoring purposes for Calendar Year (CY) 2017 NHSN BSI data.

If you have any questions or concerns regarding the extension, please contact the CMS ESRD QIP team at esrdqip@cms.hhs.gov  with "AKI" in the subject line.
If you have questions regarding how to remove patients with AKI from data reported to NHSN, please contact the NHSN helpdesk at NHSN@cdc.gov with "Dialysis" in the subject line.
Helpful New Tracking Tool Added to CROWNWeb

Have you worked in CROWNWeb lately? If not, don't miss out on the new End-Stage Quality Report and Systems (EQRS) Facility Dashboard. This dashboard will help your facility track the many important forms that are due to CMS, as well as progress with your data entry. It allows you to view the 2728 forms in three categories: New, Due, and Past due forms.  The dashboard also helps facilities track:
  •  2746 Forms
  •  Notification & Accretions
  •  System Discharges
  •  PART
  •  Clinical Depression Screenings
  •  Pain Assessments
  •  Form 2744
  •  Clinical Data 
Use the EQRS Facility Dashboard to help ensure that your facility is meeting ESRD QIP requirements  and achieving compliance with CMS data submission guidelines. Check out the new dashboard to see all the new features!
Previewing Your Facility's 2016 Performance Data
The preview period for reviewing your facility's 2016 performance data will begin July 17, 2017, when CMS will make the preview Performance Score Report (PSR) available to facilities.  These reports show the performance results that CMS will use to determine if a facility will incur a payment reduction for Payment Year (PY) 2018. 
For information about the PY2018 QIP process please visit
During the month-long Preview Period, facilities can review their measure scores and ask CMS questions about how their scores were calculated.  Facilities will also be able to submit one formal inquiry if they find or suspect an error in how their scores were calculated.  To access your facility's data visit https://dialysisdata.org and sign in using your Enterprise Identity Management (EDIM) sign in and password. 
For information regarding performance year 2016, which will affect PY 2018, refer to CMS ESRD Measures Manual Version 1.0.

IPRO End-Stage Renal Disease Network of New England, the ESRD Organization for Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont, prepared this material under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMS Contract Number: HHSM-500-2016-00019C.
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